"As nurses, we are the people who have to look patients in the eye and tell them we have no drugs" - Kholiswa Tota of the Democratic Nursing Organisation speaks out about the Eastern Cape health crisis.

Comment: Eastern Cape, heal thy nurses

Kholiswa Tota
At the coalface of care, nurses are bearing the brunt of the province's critical shortages.

The Eastern Cape chapter of the Democratic Nursing Organisation of South Africa (Denosa) believes that the time has come to tackle the healthcare challenges in our province.

As nurses, we are the people who have to look patients in the eye and tell them we have no drugs; we have to tell a pregnant mother that we can't take her to theatre for her caesarean section because there aren't enough nurses; we have to turn our backs when distressed patients can't breathe and we have no oxygen. A number of issues need to be addressed urgently, but from Denosa's perspective the following are critical:

  • Shortage of nurses: Health facilities are operating with skeleton staff complements because of the failure to fill vacant posts or the length of time it takes to do so, the freezing of posts that remain unfilled after several months, and the directive to fill only vacancies that arise in the current year. The situation is exacerbated by long working hours, and lack of management community support, which leads to nurses burning out.


  • Nonpayment of salaries and benefits: The delay and nonpayment of salaries dates back as far as 2007. Many nurses who should be considered for occupational specific dispensation have not been paid, or do not receive back pay.


  • Failure to fill key positions: Examples include Mthatha Academic Hospital, which has not had a nursing service manager for six years, and Livingstone Tertiary Hospital and Port Elizabeth Provincial Hospital, where this post has not been filled for the past three years. We are aware of nurses being victimised and forced to do these jobs without compensation. This flies in the face of health department policy, which is clear that, for acting positions, incumbents must be paid the difference between their permanent salary and that of the acting position.


  • Equipment and supplies shortages: We know of facilities that don't have simple diagnostic equipment, and where broken equipment is never replaced. Slow delivery of medicine and other basic necessities compromises the quality of care. These shortages are most acutely felt in rural areas. The public protector, who identified this problem when she visited Eastern Cape hospitals, has also commented on these shortages.


  • Education: Staff shortage is the reason given for denying many nurses the opportunity for further development or study leave. For example, in 2012, nurses at SS Gida Hospital were denied study leave after they had been given permission to further their studies.


  • Support and respect: To enable nurses to supply quality healthcare, there has to be support from management, the community and our clients. However, given the conditions under which they are required to work, nurses are increasingly reluctant to conduct certain procedures because they know they will be blamed if something goes wrong. This has reduced the trust between patients and nurses. The time has come to take the first step on the road to better health services for the Eastern Cape.


Kholiswa Tota is the provincial secretary of the Democratic Nursing Organisation of South Africa in the Eastern Cape. This opinion piece first appeared in the Section27 and Treatment Action Campaign investigative report released on Wednesday: Death and dying in the Eastern Cape, and is used with permission

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Eastern CapeEastern Cape Health Crisis Action CoalitionnursesDenosa